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Health care passes the House

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Health-care reform passed the House, quite literally, at the eleventh hour. It passed with a slim, two-vote margin. But it passed. That is more than has ever happened before. More than Truman or Nixon or Carter or Clinton managed. More than Rayburn or O'Neill or Gingrich managed. It is success, at least for this stage in the process. It is history, even, though it's hard to sense the importance of the moment when you watch members of Congress spend the day squabbling over the true meaning of the word freedom.

But it was also sobering. Harry Reid's job will be harder. Health-care reform passed the House with 50.5 percent of the vote. It will need 60 percent in the Senate. Pelosi had the luxury of losing 40 Democrats. When it comes to beating the filibuster, Reid probably won't be able to lose even one.

Photo credit: AP Photo/Alex Brandon.

By Ezra Klein  |  November 7, 2009; 11:48 PM ET
 
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Comments

Somewhere Ted Kennedy is smiling . . .

Posted by: Rick00 | November 8, 2009 12:04 AM | Report abuse

Yes indeed the Senate will be different. But voting no in the House, as 39 Democrats did on this bill, will be different when it returns from Conference Cte as a more moderate bill. They can then say that they tried to scale it back but now they must vote for it because the American people need health reform...or something like that, blah, blah, blah.

The real courageous person tonight was Rep. Cao of Louisiana, the only Republican to cross party lines and vote for it.

Posted by: LindaB1 | November 8, 2009 12:06 AM | Report abuse

Quite a close vote. Without that one GOP vote Pelosi was really tight. Still, it is a big achievement for her.

I expected margin of at least 10. So not sure where the fissures are and for what reasons those members turned around.

This razor thin margin makes Conference bill tilted more towards Center and PO chances getting dim.

If it brings all the good part of Baucus bill, that will be good. Funding mechanism is the weakest link in the House bill and to the extent it aligns with Senate way of funding, one can say Congress would have achieved what is best in given circumstances.

Senate will have the pressure to introduce the bill soon - probably first week of December.

I am thinking late Jan for President to sign. Any delay than that will be expensive.

Posted by: umesh409 | November 8, 2009 12:38 AM | Report abuse

"The real courageous person tonight was Rep. Cao of Louisiana, the only Republican to cross party lines and vote for it."

Well, he wants to keep his job, and represent his district, and he seems to have his head screwed on.

The real cowards are Blue Dogs like millionaire Heath Shuler, who think that they can keep their seats by flouncing around in an ideological corset of their own making, instead of doing something that would make a real difference to hundreds of thousands of people in their districts.

Posted by: pseudonymousinnc | November 8, 2009 12:44 AM | Report abuse

Ezra: "Health-care reform passed the House with 50.5 percent of the vote."

True. But we don't know what the internal House politics were. It could be that once supporters knew they had 218, then others in tough districts who would have voted yes if needed were given the latitude to vote no. There may have been more votes there if they were really needed.

So we don't really know if that 2-vote margin represents the number of members willing to vote yes if necessary. Maybe it does, but I wouldn't be surprised if it didn't.

Posted by: dasimon | November 8, 2009 12:47 AM | Report abuse

It's ill-advised to pass such a consequential bill with razor thin margins in the teeth of public opposition. Here's hoping wiser heads prevail in the Senate. If not, the Dems deserve to pay a terrible price at the polls.

Posted by: tbass1 | November 8, 2009 12:47 AM | Report abuse

Well you can count Kucinich as essentially a "pro" vote so the margin is 221 vs. 214 or a margin of 7. Still not impressive to lose all of those Democrats.

Democrats I believe missed an enormous chance to reconfigure and reframe the debate on healthcare, leaving them with the only strategy to beg and borrow for votes at the margins. Grayson had the right idea in terms of the politics though not necessarily anything new about policy but he was too late and too junior to have a big effect.

What we have is a bill that is largely tailored to the dominance of the mistaken ideas about government's role in healthcare that have promoted by the opponents of healthcare reform. Ultimately with Obama's victory there was an opportunity to start to make headway towards real reform. This bill is the shadow of real reform.

http://healthcare4us.wordpress.com

Posted by: michaelterra | November 8, 2009 1:06 AM | Report abuse

I wonder what kind of reception those who voted for this bill will get when they go home for Veteran's Day? They sure don't have much cover in the narrowest of margins.

Posted by: annetta3 | November 8, 2009 1:32 AM | Report abuse

Usually the Senate squeaks out a bill and the House has to swallow whatever the Senate is able to pass.

I think with Health Care the tables may be turned. With razor thin margins in the House for this bill the Senate may be forced to accept the the House legislation.

Any Senate change that picks up Blue Dog (which would have to be a BIG change) risks losing six votes of other Democrats who just barely accepted this Pelosi compromise.

This should be interesting.

Posted by: cautious | November 8, 2009 2:51 AM | Report abuse

Ezra, you said:
"Health-care reform passed the House with 50.5 percent of the vote. It will need 60 percent in the Senate."
Didn't the House have an earier vote to advance the bill that got many more than 220? Wouldn't that be the equivalent of the votes needed to break the filibuster?

Posted by: john_boston | November 8, 2009 6:59 AM | Report abuse

If you replaced the gavel with a scythe, Dingell would look just like the grim reaper. Also, how naive is it to think that the democrats who voted against were not given permission to do so????? Though if this was such a great and noble thing to do, why did they even seek that permission? why not walk with the giants?

Posted by: truck1 | November 8, 2009 7:17 AM | Report abuse

The House is DIFFERENT than the Senate. The Senate needs 60 votes for cloture. They don't needs 60 vote for the legislation. All they need is 50 votes.

The 220 margin in the House means that Nancy Pelosi allowed many Democrats in tough districts in 2010 to get a pass.

2 MAJOR things are going for the Democrats for passing health care legislation in both the House and the Senate.

Every Democrats KNOWS that if they don't pass health care reform then Democrats WILL stay home in 2010 the way they did for the governors' races in Virginia and New Jersey. As a result, Democrats could lose BOTH the House and the Senate.

Senator Reid KNOWS that if he doesn't pass health care reform he WILL LOSE in 2010. As a result, he has all the insentive in the world to PASS THIS LEGISLATION.

Democrats just get this thing done.

Posted by: maritza1 | November 8, 2009 7:49 AM | Report abuse

Meanwhile, female Democrats (you remember us, right? Huge Democratic voting bloc, the ones with the vaginas?) are in shock that we were tossed under the bus - again.

Remember last year, when women were told the Democrats were the last line of defense for Roe v. Wade? We were silly enough to believe it.

If the Stupak amendment isn't taken out of the final version, Democrats will have a serious problem with women. I mean, they already do for letting it get this far, but it'll be much worse.

Posted by: uberblonde1 | November 8, 2009 8:55 AM | Report abuse

This is a very poorly thought out piece of legislation. Being historic is not the same thing as being intelligent. Stupidity is generally more memorable than well thought out legislation.

The Dems better hurry. They only have one year left.

Posted by: fallsmeadjc | November 8, 2009 10:29 AM | Report abuse

Procedural question: If Frisk can threaten the "nuclear option" to break the filibuster, why can't Reid do the same?

Posted by: philipc2000 | November 8, 2009 12:04 PM | Report abuse

Ezra made a great point that the "debate" in Congress was relatively reflexive (or whatever language he used; reactionary, superficial, whatever), and that the real debate had happened already in blogs, think tanks, etc.

I get that.

But, in fact, the *real* debate is ongoing, and is *not* limited to blogs, think tanks, etc.

It's up in the air, and whether reform will be rather marginal, or something more, is up in the air.

The real debate isn't by experts, it's inside the minds of many scattered "independents", etc., and even in many that identify with parties or ideologies (some of them).

It's fun to think bloggers lead the debate or have concluded much of the debate, etc.

That's false.

The debate is open, and not yet concluded.

Any of us can take part by discussions with other people, anywhere.

Anyone having a real discussion somewhere is equally important to any analyst, economist, blogger, etc.

This debate will continue for years. Even after reform is passed, the way it will be implemented will be flexible, and to be determined. Politically.

Posted by: HalHorvath | November 8, 2009 1:26 PM | Report abuse

Let me be more clear on what I am saying. Sure, the details of reform are determined by experts largely, but only according to what is acceptable politically.

Further, what is acceptable politically is dynamic, changing.

There is a national discussion, which is really the crucial discussion, and it is across the nation, and it's not about technical details.

It's about a more basic issue:

http://findingourdream.blogspot.com/2009/11/great-debate.html

Posted by: HalHorvath | November 8, 2009 1:34 PM | Report abuse

Ezra, I'm thrilled as well, but I think it's an exaggeration to say that this has "never been done," like ever ever ever in history. This is a huge step, but bigger than Medicare? Medicare and the other big reforms (some more reformatory than others) caused problems as well as solving them--I'm sure that will be true this time as well. However, y'know, huge yay.

@uberblonde1 -- Speak for yourself, not all women, please. While the amendment is loathsome, I'd have made the same choice as Nancy Pelosi (also, you know, a woman).

Of course those stupid, mean spirited bullies picked on poor women. That's what they do. This isn't and will not be over--it will take ongoing political efforts and charity (yes, much maligned and politically pitiful, but really helpful sometimes). It's a huge betrayal of the interest of poor women, and all women, to threaten to put our care in the hands of the Republicans because (shock!!!) there are a lot of sexists in congress and the USA. Talk about throwing people under the bus.

Posted by: JaneG | November 8, 2009 3:51 PM | Report abuse

This piece of analysis is pretty naive; the sort of thing you'd hear from some CW spouting talking head. For one thing, as many have pointed out above, the 39 "no" votes mean nothing other than there are a lot of Dems in Rep leaning seats whose votes weren't needed. In fact, I know of one congressperson (sorry, can't name names) who actually WANTED to vote for the bill but was talked out of it because of the district involved. Also, the strategy here is to cut it as close as you can, NOT to rack up a big margin. For one thing, if you win by 20 votes you presumably don't have as aggressive a bill as you could have. For another, your strongest argument to the Senate during conference is if you've passed the bill with nothing to spare. If you pass by a lot of votes, the Senate has all the leverage.

What's encouraging is that Pelosi seems to have a pretty rock solid understanding of her caucus. That hasn't always been the case, but she's doing very well right now. Harry?

Posted by: WizintheRockies | November 8, 2009 8:48 PM | Report abuse

Ezra, think "reconciliation". Lieberman can spend his impotent last days appearing on Fox news repeating the word "filibuster" until they haul him away to the Alzheimer's unit.

Posted by: cmpnwtr | November 9, 2009 12:30 AM | Report abuse

There's a lot of discussion about the Dems and the GOP, but precious little about the policy being made. When I started following this legislation, I thought we might get a public option that offered affordable health insurance to everyone who wanted it. Now, the House bill just passed appears to be yet another gift to every corporate interest that wants a piece of the health care pie.

Where are the Democratic, much less liberal or progressive, values in this legislation?

In reality, there is no public option. The so-called public option was to provide competition against insurance companies to drive down costs and provide an alternative choice to anyone who didn't have insurance or like the one they have. It would have been open to everyone, it would have rates tied to Medicare, and it would be implemented in a relatively short period of time after the bill becomes law. The legislation contains none of these mandates

The current reform labeled as a public option only covers 2% of the population, will be administrated by private insurance companies, and will likely cost more than private insurance plans. The bill will require everyone to buy insurance, which is an early Christmas present to the insurance industry.

Posted by: johnwilliamson1 | November 9, 2009 3:39 AM | Report abuse

I would hope that Speaker Pelosi introduce a bill, immediately, that documents how she will address the fraud, waste and abuse in Medicare. This bill should lock in the 500 billion in cuts that are necessary to fund the health care legislation that she is just inflicted on the American people.

She should also introduce legislation that locks in for 10 years the doctor's cut necessary to support Medicare.

If Congress was subject to accounting rules that were similar to those that businesses are they would all be on there way to the penitentiary, with Bernie Madoff!

Posted by: mwhoke | November 9, 2009 7:48 AM | Report abuse

What a disgrace. It's another big nail in Freedom's coffin, and the repercussions will be far and wide. Visualize the American people, nailing themselves into a box.

The entire health care system is on the verge of being consigned to mediocrity, and from there, decline, but that will be only one of the outwardly visible aspects of this tragedy.

The real damage is already abundantly evident in the popular notion that holds that two thousand pages of coercion, political control, mandates, and the like can or will trump the one thing that has produced more prosperity and equality in the history of man than anything else: freedom and free exchange among humans. Bye bye to it all. Welcome to the Department of Motor Vehicles of Your Life.

Posted by: msoja | November 9, 2009 9:40 AM | Report abuse

msjoa: "It's another big nail in Freedom's coffin"

Yes, like all those poor oppressed people in our peer nations who are subjected to their health care systems, which even under the most drastic legislation under consideration we won't even begin to approach. Freedom-loving people should support the liberation of Canada, Europe, and New Zealand immediately!

Please, ask those people if they are oppressed, or if most of them would trade their system for ours. This "freedom" meme is such a canard. Citizens of our peer nations are free to quit their jobs and be entrepreneurs without fear of losing their health insurance. They're free to change jobs without worrying about health benefits packages. They're free to accept jobs that puts them over the medicaid threshold when they would otherwise lose medicaid coverage for an uninsurable family member who has as preexisting condition.

It's hard to see how health care reform is going to diminish American competitiveness. Indeed, it might help business from going bankrupt.

It's not as if we're operating in an informational vacuum here. We have plenty of examples of other nations which get comparable results to us while we spend 50% more. I'd venture that that extraneous spending translates into a pretty serious restriction on many people's "freedom." (Yes, I know lifestyle may account for some of the disparity, but not 50% worth.)

Posted by: dasimon | November 9, 2009 12:06 PM | Report abuse

"...The entire health care system is on the verge of being consigned to mediocrity, and from there, decline..."

No, the real picture is more interesting and dramatic. The entire health care system has enjoyed a price bubble, in somewhat the same way as the 2000s-era housing bubble and the stock market bubble of 1999. Therefore, instead of "mediocrity", it is in danger of...price competition.

ouch.

Which could lead to some bankruptcies and/or significant layoffs.

And more here:
http://findingourdream.blogspot.com/2009/10/great-american-health-care-bubble-or.html

Posted by: HalHorvath | November 9, 2009 12:24 PM | Report abuse

--"Which could lead to some bankruptcies and/or significant layoffs."--

Fabulous. With any luck it won't be as... uh... *disruptive* as, say, agrarian reform was in the Ukraine, circa 1932-33.

Posted by: msoja | November 9, 2009 12:42 PM | Report abuse

--"Freedom-loving people should support the liberation of Canada, Europe, and New Zealand immediately!"--

Yes, let's ship that stupid Statue of Liberty back to France. We don't need it anymore. Let the light go out. We want free health care.

Posted by: msoja | November 9, 2009 12:46 PM | Report abuse

msoja: "Yes, let's ship that stupid Statue of Liberty back to France. We don't need it anymore. Let the light go out. We want free health care."

I would be nice if you addressed a single argument on the merits. Are the French oppressed by their health care system? Are they somehow lacking in liberty and in need of liberation? How about the Canadians?

You don't identify how health care reform will impinge on the "free exchange among humans," nor do you explain how reform will inhibit "prosperity" or "equality." As has been pointed out many times, other nations have adopted far more comprehensive systems that are even under consideration here without sacrificing prosperity or equality. Indeed, one could argue that they are more prosperous (because they spend far less than we do) and more equal (because everyone has access to quality care).

Rhetoric is no substitute for facts or analysis. If you're not going to delve into either but instead rely on unsupported assertions of "freedom,"--and without countering examples of how our system has resulted in less freedom, not more--it's not worth my time to continue the discussion because it's clear that the facts won't matter.

Posted by: dasimon | November 9, 2009 1:47 PM | Report abuse

msoja: "We want free health care."

Oh, and who said anything about health care being free? I support actually paying for it--which all the bills under consideration actually do. It's a nice change of pace from "wars are free, prescription drugs are free, tax cuts are free" mentality that is largely responsible for much of our debt.

Posted by: dasimon | November 9, 2009 1:50 PM | Report abuse

"Meanwhile, female Democrats (you remember us, right? Huge Democratic voting bloc, the ones with the vaginas?) are in shock that we were tossed under the bus - again."

In shock? Really?! What, are you new here? Women (especially working class and poor -- because let's face it, the affluent always did and always will have options) will always be among the first to be tossed -- yes, even by the Dems. (We're in line for that right after the gays.)

I'm agreeing with you that it stinks, but I'm too jaded to be "shocked."

Posted by: Janine1 | November 9, 2009 2:18 PM | Report abuse

--"Are the French oppressed by their health care system?"--

Partly, yes. Their standard of living is "oppressed" by long fling with socialism in all sectors. It would be a long step down if most Americans had to start living like most Frenchmen. And the transition to less wealth in order to get there will be tumultuous, to say the least.

And frankly, who cares what the French are doing. I'd rather be free. I'd rather like to set my own priorities, and take my own risks with life, rather than be forced to live in someone eles's rubber room.

Posted by: msoja | November 9, 2009 3:13 PM | Report abuse

--"[W]ho said anything about health care being free?"--

Just the alleged forty million raison d'etres who don't have insurance now, who are just about to jump on everyone else's insurance/doctor bill.

Posted by: msoja | November 9, 2009 3:28 PM | Report abuse

"Just the alleged forty million raison d'etres who don't have insurance now, who are just about to jump on everyone else's insurance/doctor bill."

... and pay 40 million premiums.

Posted by: Janine1 | November 9, 2009 3:59 PM | Report abuse

--"... and pay 40 million premiums."--

And how are they going to do that in the future, when they can't do it now?

Posted by: msoja | November 9, 2009 4:20 PM | Report abuse

"And how are they going to do that in the future, when they can't do it now?"

You assume that all of them are uninsured for financial reasons. Many of them can't get insurance because of pre-existing conditions or because policies in the individual market are prohibitively expensive. Many others could get insurance and could afford it but choose not to. Yes, I understand that you oppose mandates, but the mandate will get those people into the insurance market and put their premiums into the system. And yes, some people will need full or partial subsidization, but no credible source has ever suggested (nor could they) that all or even most will.

The point is that your claim that all 40 million would be added onto everyone else's premiums and doctor bills was flatly wrong.

Posted by: Janine1 | November 9, 2009 4:25 PM | Report abuse

--"can't get insurance because of pre-existing conditions"--

Because the only valid price for insurance to a person with a preexisting condition is the cost of treating that condition. Now those costs will be paid by others, i.e., will be free to the person with the preexisting condition.

And those costs, now officially borne by others, will be added to the already high premiums they pay, forcing more people to seek subsidization, and the cycle will proceed. Costs will explode. More people will require subsidization. Congress will sell votes on the need, while pointing fingers everywhere except at socialism itself. And you'll pretend not to know how it happened.

Posted by: msoja | November 9, 2009 4:41 PM | Report abuse

Yes, SOME of those people have pre-existing conditions. (And maybe some of those people actually could afford to pay for insurance, if someone would sell it to them.) But you're STILL assuming that all or most of the 40 million are going to be subsidized by others. And you're still conspicuously ignoring the effect of premiums paid by the young and healthy, and of people who are healthy but can't currently afford individual policies because of the price gouging in that particular market, compared to group markets.

Posted by: Janine1 | November 9, 2009 4:55 PM | Report abuse

--"You're STILL assuming that all or most of the 40 million are going to be subsidized by others."--

It'll be forty million or more, by far. In fact, it is already much higher. Government already pays (in the political parlance) fifty percent of the health care bills in the country. How much more is going to be laundered through the treasury is anyone's guess, but if the bureaubots were just going to send the loot back where it came from there'd be no sense in any of it (not that there is any sense in any of it.)

And the costs to private individuals and business? Fergeddahboudit.

--"premiums paid by the young and healthy"--

Hmm. Last I heard, unemployment for the under twenty five crowd was something like twenty five percent. Probably higher now. So we're just at traditional European type numbers. And where are the working young going to get, what is it... $7,000 a year? There's a reason young people don't buy insurance, and it isn't because they think they're invincible.

No, health care is going to be like the general tax rolls. To paraphrase something I've seen several times the last couple days: Half the country will vote to force the other half to cough up the money for it.

Posted by: msoja | November 9, 2009 5:48 PM | Report abuse

msoja:

Again, do facts matter?

You say the French aren't "free." They don't live in a free society? Really? They can't say what they want, think what they want? They've made somewhat different social choices than we have, but I have a hard time saying that they're not "free." Does our "socialized" education system make us less free? Even school vouchers, under your theory, make us less free and should be avoided. But I doubt an absence of education for those who couldn't pay for it on their own would be good for just about all of us in the long run.

And, as I have pointed out twice and not been refuted, our health care system arguably imposes a substantial hindrance on "freedom."

"Because the only valid price for insurance to a person with a preexisting condition is the cost of treating that condition. Now those costs will be paid by others, i.e., will be free to the person with the preexisting condition.

"And those costs, now officially borne by others, will be added to the already high premiums they pay, forcing more people to seek subsidization, and the cycle will proceed. Costs will explode."

Again, do facts matter to you? Our peer nations have covered everyone, even those with preexisting conditions, for decades. And costs have not exploded. To the contrary, we still spend over 50% more than they do.

And any one of us could develop that condition, lose a job, and become uninsurable. It's not illogical, or even economically inefficient, to have a system that insures against that contingency.

We are not operating in a speculative vacuum. There are facts out there. There are examples of how other countries have done things. It might be useful to look at them before making unsupported, and sometimes demonstrably false, assertions. Otherwise it's not worth having a discussion.

Posted by: dasimon | November 9, 2009 6:24 PM | Report abuse

--"[The French] don't live in a free society?"--

I wouldn't call it free. In Paris, in '97 I think it was, a friend we were visiting brought an oil painting, inherited some three or four years before, out of a back room closet, to show us. He kept it back there to hide it from the tax man, and to hide it from any jealous neighbors or acquaintances who might report him to the tax man. That's France, and it's not free.

--"[The French] can't say what they want, think what they want?"--

Wikipedia: "[T]he 1990 Gayssot Act ... prohibits racist or/and religious hate speech (under which negationism, in particular but not only Holocaust denial falls under), and time period allocated to each political party during pre-electoral periods. Furthermore, other laws prohibit homophobic hate speech, and a 1970 law prohibits the advocacy of illegal drugs." Look under "Censorship in France", complete with reference to the Ministry of Culture, with lists of censored books, songs, and films.

--"Does our 'socialized' education system make us less free? ... vouchers ... an absence of education for those who couldn't pay for it"---

Our socialist education system makes us stupid, and less free. Vouchers are ridiculous; quit stealing the fruits of people's labor just to give it back to them. And if you look closely, you'll find that our public schools aren't erasing that "absence of education" that you ostensibly are worried about. Millions upon millions are wasted in this country trying to teach children who have no interest or ability in being educated. And a large bulk of the worthwhile kids are mis-socialized in the cess pools that are our public schools. The whole thing is a failure.

--"[O]ur health care system arguably imposes a substantial hindrance on 'freedom.'"--

Ironic, isn't it, that your notion of freedom is dependent upon the explicit threat of force by the I.R.S. and other tax collecting bodies, by government against its citizens?

--"Our peer nations have covered everyone, even those with preexisting conditions, for decades. And costs have not exploded."--

Health care systems around the world are in crisis. Europeans are exploring ways out of their socialist failures. Ditto with Canada. And none of them are the U.S., meaning that if you're expecting European results with socialism imposed on these states, you're in for a rude awakening (which, I daresay, you are.)

--"And any one of us could develop that condition, lose a job, and become uninsurable. It's not illogical, or even economically inefficient, to have a system that insures against that contingency."--

Just keep telling yourself that as costs continue to rise (at what point in the socialist system do you quit blaming pharmeceutical cos., or capitalism), and doctors become harder to find. It'll be fun.

Posted by: msoja | November 9, 2009 7:33 PM | Report abuse

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